Provider Demographics
NPI:1386797090
Name:LAWRENCE, GRETCHEN A (DPM)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:A
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 N MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3840
Mailing Address - Country:US
Mailing Address - Phone:828-452-4343
Mailing Address - Fax:828-452-1477
Practice Address - Street 1:707 N MORGAN ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3840
Practice Address - Country:US
Practice Address - Phone:704-487-6672
Practice Address - Fax:704-487-1859
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC547213EP1101X, 213ES0103X, 213ES0131X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2437012Medicare PIN